Florida Doctor Questions Lab Test Pre-notification

United Healthcare’s lab order system could slow down office workflow, says physician

CEO SUMMARY: An interesting tug-of-war may develop in Florida between a major health insurer and physicians. UnitedHealthcare will require physicians to obtain a pre-notification number for 81 lab tests by using the BeaconLBS system (developed by a subsidiary of LabCorp). One family practice physician is speaking out about his concerns that the new UHC requirement is “onerous” and will cause significant “work flow interruptions for office-based physicians.”

PHYSICIANS IN FLORIDA are just learning about a new decision support laboratory requisition form for the laboratory that performs these tests to be paid Florida Medical system for clinical laboratory tests that goes into effect this month.

The Laboratory Benefit Management Program created by UnitedHealthcare will launch on October 1 in Florida for fully-insured commercial beneficiaries. It is operated by BeaconLBS, a business division of Laboratory Corporation of America. The health insurer is requiring physicians to use the system for pre-notification or preauthorization of approximately 81 clinical lab tests. (See TDR, July 21, 2014.)

For clinical labs and pathology groups serving UHC patients in Florida, the implementation of the BeaconLBS pre- notification program has been a most unwelcome development. Only about 18 lab companies (five owned by LabCorp) signed up to participate.

But little has been heard from the physicians who will be required to use the BeaconLBS system for pre-notification for the designated laboratory tests. This pre-notification number must appear on the laboratory requisition form for the laboratory that performs these tests to be paid by UHC. Both the Florida Medical Association and the Florida Academy of Family Physicians have asked their members for comments about their experience when they begin using the BeaconLBS system for their UHC patients.

One Florida physician said that the new system will be challenging, frustrating, and time-consuming. He also pointed out that this time-consuming requirement comes with no additional revenue and there is no proof that it will improve patient care.

Most Doctors Unaware

“The requirements of this system are onerous and the work flow interruptions for office-based physicians will be substantial,” observed Dennis Saver, M.D., a family physician and geriatrician and founder of Primary Care of the Treasure Coast, in Vero Beach, Florida. “There are few better examples of an unfunded mandate than this Beacon system,” added Saver, an adjunct clinical associate professor at the University of Florida School of Medicine and a clinical associate professor at the Florida State University College of Medicine.

While the FMA and FAFP have asked for physician comments, most doctors are unaware that the BeaconLBS system will change workflow, Saver said. “I have not heard much yet, perhaps because most docs have no clue what will befall them on October 1,” he added.

Saver said his three most significant concerns are these:

1) The BeaconLBS system will be time-consuming for physicians who must use it.

2) UHC has proposed no increase in pay to physicians for this additional work.

3) The BeaconLBS decision support system is not, at this time, integrated with many of the electronic health record (EHR) systems physicians use. This means physicians may need to enter lab test orders twice.

“It will be time-consuming, complicated, and frustrating—all for no change in pay!” noted Saver. “A lot more work for the same pay constitutes a decrease in the pay rate. Period.

Is It a Contract Change?

“And UnitedHealthcare has presented this unilateral move as a policy change; but I consider it to be a contract change,” he continued. “Unfortunately, UnitedHealth has a reputation for using their large market presence to dictate contract terms, which they are doing here.”

Saver had his office staff review the procedures to obtain lab test pre-notification from the BeaconLBS system. The staff determined that a single test order will require five to seven extra minutes. Staff also estimated that between 20 and 30 mouse clicks and multiple computer screen changes will be needed to enter the information for each patient requiring lab testing through the BeaconLBS portal.

Compounding the problem is the fact that BeaconLBS is integrated with only a few EHRs. THE DARK REPORT spoke with a director at one of the nation’s largest companies providing revenue and payment cycle solutions and connectivity services for providers. It supports a portal integrated with many EHR systems that enables electronic lab test ordering and resulting.

Double Order Entry for Tests

He confirmed that his company has integrated its software with the BeaconLBS system, meaning client physicians can use their EHR systems normally, without double entry. However, he noted that physicians who are not clients of his company will find the BeaconLBS system requires them to enter clinical lab orders twice: once for BeaconLBS and once in their EHR. “Physicians using that method for ordering lab tests and getting a pre-notification number will do twice the work,” he said.

UHC has said BeaconLBS is working to integrate its decision support system with all EHRs. But this expert does not expect Beacon to have all EHRs integrated for the soft launch of the program September 2 or the official launch on October 1.

Physicians whose EHRs are not integrated with the BeaconLBS program will need to leave their EHRs to then open the BeaconLBS program, find the patient’s name, and follow the steps to order the required tests. That begins the process of providing the additional information to complete the physician decision support for the tests, a process that Saver’s staff estimates will take in total five to seven minutes.

For his part, Saver further pointed that, “because the BeaconLBS system is designed to ensure compliance with clinical guidelines for laboratory testing, it will no longer be possible for physicians to hand off lab test ordering to a nurse or medical assistant, as is common in most offices.

“This is not something the physician can delegate,” he explained. “Given that the BeaconLBS system will require extra time to open the portal, find the patient, and follow all of the steps to accomplish the decision support, there should be a proportional increase in visit pay [to the physician] because there is going to be an increase in time for those patients who need lab testing.”

Most primary care physicians schedule patients every 10 to 15 minutes, making five to seven extra minutes a substantial increase in visit time. To date, Saver said UHC has not answered his question about whether it will pay physicians for this additional time.

Physician Compensation?

“I have been on two different calls with UnitedHealthcare under two different circumstances,” he commented. “Each time, I asked if physicians would be compensated, and each time the response was silence. They did not respond.”

THE DARK REPORT asked BeaconLBS and UHC about compensating physicians for the additional time. As of press time, neither company had answered this question. The two companies were also asked to provide information about how many EHR systems were compatible with the BeaconLBS system and no answer was provided.

UnitedHealthcare of Florida and BeaconLBS did each provide a statement in response to a list of questions submitted by THE DARK REPORT. Those statements are reproduced in their entirety here.

Statements by UnitedHealth

A spokesperson for UnitedHealthcare addressed the question of EHR compatibility, saying, “If you use a laboratory ordering system or EHR application that’s already integrated with [Beacon’s] physician decision support [system], a practice’s workflow will not need to change. The application will automatically identify members who are part of the laboratory benefit management program and lead the provider’s staff through the process for advance notification or prior authorization for decision support tests. If the practice is not using an integrated laboratory ordering system, it can use the standalone application at BeaconLBS.com to order decision support tests for members who are part of the laboratory benefit management program.”

Saver was careful to point out that not all patients require lab testing. “However, for those who do, the increase in visit time is a concern,” he noted.

Another factor is the mix of patients a physician sees, which can drive the number of lab tests ordered. “I see mostly geriatric patients; however, if I were in a younger market and 40% of my patients were with UnitedHealthcare, I believe this would slow me to a halt,” observed Saver. “Typically in a younger population, about 25% to 30% of patients may need some lab testing and the thing that I do not know is what percentage of patients will need one or more of the 81 tests on the Beacon list.

“That percentage could be greater and it will require some time for a physician using the stand-alone portal to learn and remember which lab tests are on the BeaconLBS pre-notification list,” he said. “That means the learning curve will be steep and there is no evidence that this effort does anything to improve patient care.

“As a contracted physician for UnitedHealthcare, I find this whole idea that we need to do more work for no additional pay to be extraordinarily objectionable!” declared Saver. “And, frankly, I find UnitedHealthcare’s argument that this will create better medicine to be unsupported. This simply means that UnitedHealth will pay less in lab fees.”

Saver identified another problem that is likely to occur each time a physician does not go through the BeaconLBS system for a listed test. “That test becomes a noncovered service and that means patients will be billed for those tests,” he noted. “That alone will create a huge uproar. The patients will not understand that it is UnitedHealthcare’s decision to deny the test.

Patients May Blame Docs

“Instead, they’ll think it’s the doctor’s fault for not filling out the papers correctly to get the test covered,” predicted Saver. “Furthermore, each time a patient needs to use an outside lab for testing, the physician will have to print off the decision support information and give it to the patient to make sure that the tests are covered. Then, if the patient doesn’t pay the lab at time of service for a test on the list which has not gone through the physician decision support system, the lab will need to pursue the patient to collect its payment.”

Dr. Saver’s questions and observations raise valid points about UnitedHealthcare’s Laboratory Benefit Management Program. In today’s era of patient-centered care, will the patient be better served by this complicated arrangement?

Florida Physician Asks: Why Is Decision Support Required for Some Tests the CDC Recommends?

IF THE FEDERAL CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) recommends a certain clinical laboratory test, why is that test required to go through decision support? That’s a question Dennis Saver, M.D., founding president of Primary Care of the Treasure Coast, in Vero Beach, Florida, wants answered.

The 12-physician practice already has a moderately complex in-office lab and so the physicians understand lab testing, he said.

“We have negotiated to perform certain tests in-house,” noted Saver. “For all other laboratory tests for UnitedHealthcare members, we are required to refer to Laboratory Corporation of America. In our circumstance, we might not have an option except to send orders to LabCorp, even if one of our physicians wanted to refer a specific patient’s specimen to another laboratory.”

In cases where evidence-based medicine guidelines are established for specific clinical lab tests, Saver questions the need to have such test orders go through the new BeaconLBS decision support system.

“As I understand it, each time a patient needs a Pap smear, that test request must go through the new BeaconLBS decision support system,” stated Saver. “When you look at the list of tests that require decision support, every Pap smear has to go through it and every test for Chlamydia and Gonorrhea. This despite accepted clinical guidelines and the fact that these screening tests are required for HEDIS reporting.

“Plus, the Centers for Disease Control and Prevention has recommended that all baby boomers be screened for hepatitis C, yet the hep C screens are on the preauthorization list,” he continued.

“The CDC guidelines also say every adult should be screened for HIV and that lab test is on the preauthorization list,” observed Saver. “If these tests are recommended by expert organizations, why is decision support required before physicians can order such tests?”

Perhaps a bigger concern, noted Saver, is how quickly the number of tests designated for decision support may be increased by UnitedHealthcare. “In this proposal, these 81 tests are the first volley,” he stated. “When does the second shoe drop and the third and the fourth, and we end up needing to obtain preauthorization for hundreds of lab tests? If physicians find this system onerous at inception, how much more intrusive and time-consuming will it be down the road?”



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